The common theme for this Center of Excellence is improvement of drug safety across the continuum of care in diverse patient groups. The investigators have already performed many studies in the field of medication and medical errors and have a record of collaborative cross-disciplinary work. The six projects and two cores in this application will extend these previous studies to new populations and settings, as well as bring researchers together in synergistic ways through new working relationships. Much of the information regarding medication safety available to date comes from adult inpatients, and it is critical to broaden this knowledge to other settings and populations. We will perform studies involving inpatients, outpatients, and nursing home patients, as well as pediatric, adult, psychiatric, and frail elder groups. We will also evaluate novel approaches to reporting of errors and adverse events. In addition, we will test information technology, engineering, and human factor approaches to preventing errors. We propose six projects, with one or two addressing each of the key domains. Two of the projects go beyond the medication domain, but all will relate to medications in some way, and the two that go beyond medications will have links to all the medication-related projects. Thus, we will: 1) augment reporting of and learning from all medical errors by moving from local to system-wide error reporting; 2) expand the epidemiological knowledge of medication errors in vulnerable patient groups, including the ambulatory pediatric and inpatient psychiatric settings; 3) develop and validate a tool to rapidly assess the culture of an organization and its attitudes regarding error; and 4) evaluate both novel medication safety interventions (e.g., an intravenous system to reduce the frequency of administration errors) as well as interventions used in novel settings (e.g., psychiatry). We feel that this work in the aggregate will make important contributions to the field of patient safety.